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  1. Article ; Online: Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study.

    Jain, Amiti / Goldberg, Zachary N / Briggs, Erin / Amin, Dev R / Urdang, Zachary D / Goldman, Richard A / Cognetti, David M / Curry, Joseph M

    The Laryngoscope

    2024  

    Abstract: Objective: The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure ... ...

    Abstract Objective: The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population.
    Methods: Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI-5 = 0.
    Results: A total of 9,081 patients were included in the final analysis. Greater mFI-5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5-year mortality were 1.93 (p = 0.0003) for mFI-5 = 2 and 1.90 (p = 0.0002) for mFI-5 = 3. Odds of 2-year mortality were 1.25 (p = 0.0125) for mFI-5 = 1, 1.58 (p = 0.0002) for mFI-5 = 2, and 1.87 (p = 0.003) for mFI-5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI-5 = 2 and 1.78 (p = 0.05) for mFI-5 = 3. Two-year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI-5 = 2 and 2.84 (p < 0.0001) for mFI-5 = 3. Two-month odds of pneumonia were 1.50 (p = 0.0259) for mFI-5 = 2 and 2.55 (p = 0.0037) for mFI-5 = 3. mFI-5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5-year post-TORS death (R
    Conclusion: This study demonstrates that mFI-5 predicts mortality, pneumonia, and postoperative infection independently of age.
    Level of evidence: 4 Laryngoscope, 2024.
    Language English
    Publishing date 2024-04-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.31458
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  2. Article: Evaluating YouTube videos on sialendoscopy as an educational resource for patients.

    Campbell, Daniel J / Xiao, Kevin / Mastrolonardo, Eric / Cognetti, David M

    Laryngoscope investigative otolaryngology

    2022  Volume 8, Issue 1, Page(s) 82–88

    Abstract: Objectives: Patients are increasingly relying on YouTube for health information. We objectively evaluated the quality and comprehensiveness of sialendoscopy YouTube videos available to patients. We further investigated the relationship between video ... ...

    Abstract Objectives: Patients are increasingly relying on YouTube for health information. We objectively evaluated the quality and comprehensiveness of sialendoscopy YouTube videos available to patients. We further investigated the relationship between video content and video popularity.
    Methods: We identified 150 videos using the search term "sialendoscopy." Videos were excluded if they were lectures for medical professionals, operating room (OR) recordings, unrelated, non-English, or non-audio. Video quality and comprehensiveness were evaluated using modified DISCERN criterion (range: 5-25) and novel sialendoscopy criterion (NSC, range: 0-7), respectively. Secondary outcomes included standard video metrics and Video Power Index to measure popularity. Videos were classified binarily by uploader type as from an academic medical center or from other sources.
    Results: Twenty-two (14.7%) of 150 videos were included for review, with 7 (31.8%) uploaded from academic medical institutions. One hundred-nine (72.7%) videos were excluded as lectures for medical professionals or OR recordings. Overall mean modified DISCERN (13.45 ± 3.42) and NSC (3.05 ± 0.96) scores were low; however, videos uploaded by academic medical institutions were significantly more comprehensive (NSC mean difference = 0.98, 95% CI: 0.16-1.80,
    Conclusions: This study highlights the paucity and low quality of sialendoscopy videos for patients. More popular videos are not higher quality, and most videos are targeted more toward physicians rather than patients. As YouTube becomes increasingly used by patients, there is opportunity for otolaryngologists to produce more informative videos for patients while implementing targeted strategies to increase viewership.
    Level of evidence: NA.
    Language English
    Publishing date 2022-12-16
    Publishing country United States
    Document type Journal Article
    ISSN 2378-8038
    ISSN 2378-8038
    DOI 10.1002/lio2.991
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  3. Article ; Online: Otolaryngology Subspecialty Surgical Rescheduling Rates During the COVID-19 Pandemic.

    Sagalow, Emily S / Duffy, Alexander / Selvakumar, Priyanga / Cognetti, David M

    OTO open

    2022  Volume 6, Issue 1, Page(s) 2473974X221091156

    Abstract: Objective: In the beginning of the COVID-19 pandemic in spring 2020, elective and oncologic surgical cases were cancelled. After adequate safety protocols were established, each subspecialty within otolaryngology faced unique challenges in reengaging ... ...

    Abstract Objective: In the beginning of the COVID-19 pandemic in spring 2020, elective and oncologic surgical cases were cancelled. After adequate safety protocols were established, each subspecialty within otolaryngology faced unique challenges in reengaging patients for surgical scheduling.
    Study design: Retrospective review from March to May 2020.
    Setting: Single academic institution.
    Methods: Patients whose otolaryngology surgery was cancelled due to COVID-19 hospital precautions were identified. Rescheduling rates were analyzed by subspecialty. Case completion was determined as the percentage of initially cancelled cases that were completed within 6 months of their original planned dates.
    Results: Of 833 otolaryngology cases scheduled between March 16 and May 29, 2020, a total of 555 (66.63%) were cancelled due to COVID-19 precautions, and 71.17% were rescheduled within 6 months. Cancellation and rescheduling rates per subspeciality were as follows, respectively: head and neck surgery, 42.79% and 88.76%; sleep surgery, 83.92% and 64.07%; rhinology and skull base, 72.67% and 64.80%; facial plastic and reconstructive surgery, 80.00% and 74.17%; otology and neurotology, 71.05% and 66.67%; and laryngology, 68.57% and 79.17%. The case completion rates were as follows: head and neck surgery, 95.2%; laryngology, 85.7%; facial plastic and reconstructive surgery, 79.3%; otology and neurotology, 76.3%; rhinology and skull base, 74.4%; and sleep surgery, 69.9%.
    Conclusion: Differences for surgical rescheduling rates during the COVID-19 pandemic shutdown exist among otolaryngology subspecialties. Our experience suggests that subspecialties that functioned on an elective nature were more likely to face lower rates of case completion.
    Language English
    Publishing date 2022-03-30
    Publishing country United States
    Document type Journal Article
    ISSN 2473-974X
    ISSN (online) 2473-974X
    DOI 10.1177/2473974X221091156
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  4. Article ; Online: Comment on "Tracheostomy in COVID-19 Patients: Why Delay or Avoid?"

    Goldman, Richard A / Swendseid, Brian / Cognetti, David M

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2020  Volume 164, Issue 3, Page(s) 684

    MeSH term(s) COVID-19 ; Humans ; SARS-CoV-2 ; Tracheostomy
    Keywords covid19
    Language English
    Publishing date 2020-08-18
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/0194599820953376
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  5. Article ; Online: Programmed cell death protein 1 axis blockade in locally advanced squamous cell carcinoma of the head and neck: Neoadjuvant and adjuvant approaches.

    Vathiotis, Ioannis A / Johnson, Jennifer M / Luginbuhl, Adam / Cognetti, David / Curry, Joseph / Argiris, Athanassios

    Cancer treatment reviews

    2022  Volume 109, Page(s) 102437

    Abstract: Immunotherapy and in particular programmed cell death protein 1 (PD-1) inhibitors have been applied not only in the management of recurrent or metastatic disease but also as component of potentially curative treatment for many solid tumors. The ... ...

    Abstract Immunotherapy and in particular programmed cell death protein 1 (PD-1) inhibitors have been applied not only in the management of recurrent or metastatic disease but also as component of potentially curative treatment for many solid tumors. The incorporation of immunotherapy as neoadjuvant and /or adjuvant therapy in the treatment paradigm of locally advanced squamous cell carcinoma of the head and neck (SCCHN) is appealing with the goals of enhancing antitumor efficacy and, at the same time, reduce toxicity. This review analyzes the rationale for employing immunotherapy in the neoadjuvant and adjuvant settings, reviews the results of relevant clinical trials, and examines the potential benefits and caveats of neoadjuvant and/or adjuvant approaches in patients with SCCHN.
    MeSH term(s) Head and Neck Neoplasms/drug therapy ; Humans ; Immunotherapy/methods ; Neoadjuvant Therapy ; Programmed Cell Death 1 Receptor/metabolism ; Squamous Cell Carcinoma of Head and Neck/drug therapy
    Chemical Substances Programmed Cell Death 1 Receptor
    Language English
    Publishing date 2022-07-16
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 125102-8
    ISSN 1532-1967 ; 0305-7372
    ISSN (online) 1532-1967
    ISSN 0305-7372
    DOI 10.1016/j.ctrv.2022.102437
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  6. Article ; Online: Traumatic Transradial Forearm Amputation Temporized With Extracorporeal Membrane Oxygenation: A Brief Report.

    Hegeman, Erik M / Fisher, Miles W A / Cognetti, Daniel J / Plucknette, Benjamin F / Alderete, Joseph F / Wilson, David / Causey, Marlin Wayne

    Military medicine

    2023  Volume 189, Issue 1-2, Page(s) e27–e33

    Abstract: Introduction: Extracorporeal membrane oxygenation (ECMO) is typically used to provide mechanical perfusion and gas exchange to critically ill patients with cardiopulmonary failure. We present a case of a traumatic high transradial amputation in which ... ...

    Abstract Introduction: Extracorporeal membrane oxygenation (ECMO) is typically used to provide mechanical perfusion and gas exchange to critically ill patients with cardiopulmonary failure. We present a case of a traumatic high transradial amputation in which the amputated limb was placed on ECMO to allow for limb perfusion during bony fixation and preparations and coordination of orthopedic and vascular soft tissue reconstructions.
    Materials and methods: This is a descriptive single case report which underwent managment at a level 1 trauma center. Instutional review board (IRB) approval was obtained.
    Results: This case highlights many important factors of limb salvage. First, complex limb salvage requires a well-organized, pre-planned multi-disciplinary approach to optimize patient outcomes. Second, advancements in trauma resuscitation and reconstructive techniques over the past 20 years have drastically expanded the ability of treating surgeons to preserve limbs that would have otherwise been indicated for amputation. Lastly, which will be the focus of further discussion, ECMO and EP have a role in the limb salvage algorithm to extend current timing limitations for ischemia, allow for multidisciplinary planning, and prevent reperfusion injury with increasing literature to support its use.
    Conclusions: ECMO is an emerging technology that may have clinical utility for traumatic amputations, limb salvage, and free flap cases. In particular, it may extend current limitations of ischemia time and reduce the incidence of ischemia reperfusion injury in proximal amputation, thus expanding the current indications for proximal limb replantation. It is clear that developing a multi-disciplinary limb salvage team with standardized treatment protocols is paramount to optimize patient outcomes and allows limb salvage to be pursued in increasingly complex cases.
    MeSH term(s) Humans ; Extracorporeal Membrane Oxygenation/methods ; Forearm/surgery ; Amputation, Surgical ; Limb Salvage/methods ; Amputation, Traumatic/surgery ; Amputation, Traumatic/complications ; Ischemia ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2023-05-16
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usad148
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  7. Article ; Online: An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT).

    Gulati, Arushi / Cognetti, David M / Cohen, David S / Ogden, M Allison / Schaitkin, Barry M / Walvekar, Rohan R / Ryan, William R / Chang, Jolie L

    The Laryngoscope

    2022  Volume 133, Issue 3, Page(s) 539–546

    Abstract: Objective: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback ... ...

    Abstract Objective: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis-associated symptoms.
    Methods: We analyzed COSS responses via exploratory factor analysis (EFA) to identify essential symptom domains and reduce overlap in questions. Sialadenitis patients evaluated the significance of index symptoms identified from the literature review. Expert physicians rated symptom relevance in clinical assessment. An updated questionnaire (SPIT) was piloted with both patient and expert interviews to optimize structure and readability. The SPIT was assessed for internal consistency, construct validity, and test-retest stability.
    Results: EFA of 310 COSS responses demonstrated 3 main symptom domains (functional impact, pain, swelling) that explained 58.4% of response variance. Results were not statistically different when collapsing from 11 to 5 question response options. Experts (n = 5) ranked gland swelling, mealtime pain, and foul taste as most clinically important, while patients (n = 12) ranked swelling, non-mealtime pain, and difficulty eating as most bothersome. Most patients experienced sialadenitis-related functional or psychosocial impairment. Following interviews for question refinement, a 25-question survey was finalized. SPIT responses from 50 sialadenitis patients demonstrated internal consistency (Cronbach's alpha = 0.96), 14-day stability (p < 0.001), and agreement with Oral Health Impact Profile-14 scores (p < 0.0001).
    Conclusions: We developed the SPIT instrument to improve usability and content validity in chronic sialadenitis evaluation. The psychometric assessment demonstrated high construct validity and test-retest reliability. Further work will assess longitudinal changes with treatment.
    Level of evidence: 4 Laryngoscope, 133:539-546, 2023.
    MeSH term(s) Humans ; Reproducibility of Results ; Treatment Outcome ; Endoscopy/methods ; Sialadenitis/diagnosis ; Surveys and Questionnaires ; Chronic Disease ; Patient-Centered Care ; Psychometrics
    Language English
    Publishing date 2022-06-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30244
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  8. Article ; Online: Rare Parotid Gland Diseases.

    Sanan, Akshay / Cognetti, David M

    Otolaryngologic clinics of North America

    2016  Volume 49, Issue 2, Page(s) 489–500

    Abstract: The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and ... ...

    Abstract The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and pathologic analysis and molecular technology. This article reviews rare parotid diseases, discussing the respective disease's clinical presentation, diagnosis, imaging, pathogenesis, treatment, and prognosis.
    MeSH term(s) Biopsy ; Diagnosis, Differential ; Endoscopy ; Humans ; Parotid Diseases/classification ; Parotid Diseases/diagnostic imaging ; Parotid Diseases/therapy ; Parotid Gland/pathology ; Prognosis ; Radiotherapy ; Ultrasonography
    Language English
    Publishing date 2016-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 417489-6
    ISSN 1557-8259 ; 0030-6665
    ISSN (online) 1557-8259
    ISSN 0030-6665
    DOI 10.1016/j.otc.2015.10.009
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  9. Article ; Online: Risk factors for gastrostomy tube dependence in transoral robotic surgery patients.

    Philips, Ramez / Topf, Michael C / Vimawala, Swar / Luginbuhl, Adam / Curry, Joseph M / Cognetti, David M

    American journal of otolaryngology

    2021  Volume 43, Issue 1, Page(s) 103175

    Abstract: Objectives: To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence.: Methods: Retrospective chart review ... ...

    Abstract Objectives: To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence.
    Methods: Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year.
    Results: A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28-28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37-41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis.
    Conclusions: Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.
    MeSH term(s) Adult ; Aged ; Dependency, Psychological ; Female ; Follow-Up Studies ; Gastrostomy/methods ; Gastrostomy/psychology ; Humans ; Intubation, Gastrointestinal/methods ; Intubation, Gastrointestinal/psychology ; Male ; Middle Aged ; Neoplasm Staging ; Oral Surgical Procedures/methods ; Oropharyngeal Neoplasms/pathology ; Oropharyngeal Neoplasms/psychology ; Oropharyngeal Neoplasms/surgery ; Postoperative Period ; Risk Factors ; Robotic Surgical Procedures/methods ; Squamous Cell Carcinoma of Head and Neck/pathology ; Squamous Cell Carcinoma of Head and Neck/psychology ; Squamous Cell Carcinoma of Head and Neck/surgery ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2021-08-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604541-8
    ISSN 1532-818X ; 0196-0709
    ISSN (online) 1532-818X
    ISSN 0196-0709
    DOI 10.1016/j.amjoto.2021.103175
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